Request for Expression of Interest (EOI) - New Zealand Doctor

Request for Expression of Interest (EOI) for the delivery of Better,
Sooner, More Convenient Primary Health Care

Table of Contents
1. Introduction.................................................................................................................................2
1.1 The Primary Health Care service model ........................................................ 3
1.2 Coverage...................................................................................................... 4
2. Procedure and Timetable.....................................................................................................4
2.1 Eligibility ....................................................................................................... 4
2.2 District Health Board Engagement ............................................................... 5
2.3 Timetable ..................................................................................................... 5
2.4 Submitting an Expression of Interest............................................................ 6
2.5 Background information ............................................................................... 7
2.6 General enquiries......................................................................................... 7
2.7 Confidentiality............................................................................................... 8
2.8 Ownership of proposal documents............................................................... 8
2.9 Disclaimer .................................................................................................... 8
3. Content of your Expression of Interest ........................................................................9
3.1 Title of the EOI ............................................................................................. 9
3.2 Organisation details ..................................................................................... 9
3.3 Your Proposal .............................................................................................. 9
4. EOI Assessment Process ..................................................................................................11
4.1 Assessment Panel ..................................................................................... 11
4.2 Assessment criteria.................................................................................... 11
4.3 Disclaimer .................................................................................................. 12
5. Other Information...................................................................................................................13
5.1 Expectation for participants to share experience and information.............. 13
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1. Introduction
This Expression of Interest (EOI) invites proposals from eligible primary health care
providers and/or primary health care organisations or networks. Your proposal
should show how you and/or your allied organisations will help deliver the
Government’s priority intention for a more personalised primary health care system
that provides services closer to home, makes Kiwis healthier and reduces pressure
on hospitals.
Your proposal should describe your organisation’s capability and capacity to deliver
major service improvement initiatives, and show the strength of your relationships
with key stakeholders, clinicians, practitioners and the community. Your proposal
should outline how you will implement transformational primary health care service
improvement initiatives that:
• Improve people’s health and contribute to the achievement of national Health
Targets;
• Lead to the establishment of Integrated Family Health Centres in appropriate
locations that support multidisciplinary ways of working;
• Provide a wider range of health services in primary care settings that are more
responsive to the needs of the community;
• Reduce acute demand on publicly-funded hospital services;
• Better manages patients with chronic conditions to support those people living in
the community to live well and have their social and healthcare needs supported;
• Incorporate Whānau Ora approaches where appropriate;
• Demonstrate a commitment to continuing service improvement and development
to better meet the needs of communities;
• Achieve the above objectives in a way that is cost effective and assures quality
and safety for users of your services.
There will be an opportunity for amendments to existing policy settings to be
considered for successful applicants to this EOI.
This EOI opens the process for a First Wave of early adopters to implement
innovative new models of care on a large scale. It is anticipated that collectively the
First Wave will provide up to 30 per cent of New Zealanders with access to ‘Better,
Sooner and More Convenient primary health care’ within three years.
An ongoing annual process is planned to be established to invite respondents who
are unsuccessful in this First Wave, or who are not yet ready to participate, as well
as additional providers/organisations, to engage in this process beginning in
2010/11.
Existing accountabilities for realising the full vision of the Primary Health Care
Strategy will continue to remain in place. District Health Boards (DHBs) will continue
to be guided by the Primary Health Care Strategy and will work with the sector to
achieve further gains outside of this EOI process. Working towards more coordinated
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and integrated models of care will continue as a high priority to increase health gain.
The Ministry of Health will continue to support DHBs in this endeavour.
1.1 The Primary Health Care service model
The Government wishes to accelerate the implementation of the service model
improvements envisioned under the Primary Health Care Strategy 1 , and more
specifically, chapter three of Better, Sooner, More Convenient 2 . This includes:
• Devolving more treatment and diagnostic services from secondary to primary
health care, including delegated funding.
• Moving some hospital services to primary health care settings, including
Integrated Family Health Centres, to provide a wider range of services
including for example specialist assessments by GPs with special interests,
minor surgery, extended hours, walk in access, increased focus on chronic
care management, increased nursing and allied health services, as well as
selected social services.
• More specially trained nurses who act as brokers and case managers for
patients with chronic conditions, and work with health and non-health
agencies, particularly for families at risk.
• Providing a much wider range of care and support for people and their
families, through strengthened incentives for PHOs, general practice, and
other health practitioners to better coordinate the ongoing care of their
population.
The initiative is intended to trigger significant improvements in the way health and
other services are delivered within communities so that services are relevant to the
communities they serve. In this improved service delivery environment:
• It will be more convenient for the public to access a wider range of services
in their communities. There will also be greater patient choice, including
extended opening hours, walk-in access and use of email or phone
consultations.
• Local provision and increased coordination of services will benefit those with
chronic conditions requiring long term care, empowering people and their
families/whānau to manage their conditions and support self care. We
anticipate this will mean fewer visits to the hospital than otherwise
• Care will be provided at levels appropriate to need, including consideration of
the needs of the frail elderly and other vulnerable populations.
• A wide range of clinicians will be supported to work in a multidisciplinary
environment with greater scope to coordinate the best care for patients
across a wider range of providers.
1 Minister of Health. (2001) The Primary Health Care Strategy. Wellington: Ministry of Health.
http://www.moh.govt.nz/primaryhealthcare
2 Ryall, T. (Hon). (2007) Better, Sooner, More Convenient: Health Discussion Paper. Wellington:The
Office of the Leader of the Opposition. http://www.national.org.nz/files/__0_0_HEALTH_lowres.pdf
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• Clinical leadership will be actively fostered and lead the development of more
effective services for communities and support the training of primary
healthcare professionals in primary care settings;
• Clinicians and provider organisations will benefit from a more sustainable
business model, better working conditions and more flexibility in funding so
that they can get on and do what’s important for patients.
• Providers will work to reduce acute demand on publicly funded hospital
services.
1.2 Coverage
This EOI process will agree business development contracts that lead to progressive
implementation of major service improvement initiatives. Collectively, the first wave
initiatives are expected to reach up to 30 per cent of the New Zealand population
(around 1.26 million people).
2. Procedure and Timetable
2.1 Eligibility
Eligible organisations are those that can demonstrate an ability to implement large
scale and transformational service improvement initiatives for better, sooner, more
convenient primary health care.
For this first wave of implementation, priority will be given to organisations or
networks that have the ability to deliver services to populations of 50,000 people or
more. Consideration will also be given to EOIs from organisations or networks that
have the ability to deliver services to smaller populations if the proposed initiative
fully covers a significant geographical location (eg. a rural community).
Expressions of Interest will be considered from single organisations or consortia
comprising:
• Primary Health Organisations (PHOs)
• Nursing providers
• General Practices
• Management Services Organisations
• Independent Practitioner Associations
• Māori and Pacific providers
• Allied Health providers
• Pharmacy, laboratory and diagnostic services providers
• Lead Maternity Carers
• Mental health services providers
• Social services providers
• Community/residential care providers.
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2.2 District Health Board Engagement
The New Zealand Public Health and Disability Act 2000 gives DHBs responsibility for
assessing the health and disability needs of communities in their districts, and
managing resources and service delivery to best meet those needs. This includes
promoting the integration of health services, especially primary and secondary health
services.
It will be vital for DHBs to be closely involved in the development of business cases
and to support implementation of improved models of care. This support need not
involve a financial interest but should include a strong commitment to the service
improvement process. At the early EOI stage DHB support is desirable and strongly
encouraged but not essential for progressing through the initial EOI stage.
2.3 Timetable
This process has four phases:
(i) Expression of Interest: responses to the request for EOI are due by 14
October 2009 with the intention of selecting respondents to proceed to the
next phase by 4 November 2009. All respondents, successful or
otherwise, will be advised of the result of their submission on 4 November
2009.
(ii)
Business Case development: parties selected during the EOI phase will
be invited to develop a detailed business case for the progressive
implementation of new models of care, including but not limited to the
scope of services to be provided, detailed costings and a development
pathway by 15 February 2010. The Ministry will consider funding to
support the development of business cases for successful EOI applicants.
(iii) Evaluation of business cases: Evaluation of the business cases and
decisions regarding successful parties will be completed by 28 February
2010. Business cases that meet the required standards will be selected to
move into contract negotiations. Organisations whose business cases do
not meet these standards will be invited to resubmit.
(iv) Contract Negotiations: it is intended that contracts for business
development be in place by mid May 2010. Implications for contracts for
service provision will be scoped as part of business case development.
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First wave Aug – Sept 09 Oct – Dec 09 Jan – Mar 10 April – Jun 10
EOI released, Early Sept close 14
closed and Oct 2009
assessed
Business Case
detailed
Development
Contract
Negotiations
Detailed business case development to
15 Feb 2010
Contract development and negotiation
March – mid May 2010
Operational Funding models, contracting and settings to shift services – operational policy
policy settings settings reviewed over this period
reviewed
Second Wave
Review policy settings
opened and
and phasing for
progressed
subsequent waves
The first wave will pave the way for the full realisation of the Government’s intentions
for primary health care. Subsequent annual processes will provide opportunities for
other organisations/collectives to engage in this process.
2.4 Submitting an Expression of Interest
Your EOI must be delivered to Natalie Cook (the Ministry’s specified Contact Person)
at the Ministry of Health, No 1 The Terrace, Wellington by 9:00am on Wednesday
14 October (“the Closing Date”).
Your EOI must be delivered in a sealed envelope marked “Request for Expression of
Interest (EOI) for the delivery of Better, Sooner, More Convenient Primary Health
Care” in the following format:
• Two printed copies (one unbound); and
• One electronic copy on a CD ROM in Microsoft Word format.
You must not submit your EOI by facsimile or email.
You may amend your EOI at any time prior to the Closing Date specified above, or
withdraw your EOI at any time, by providing written notice to the Ministry’s Contact
Person.
The Ministry will acknowledge the receipt of EOIs and the withdrawal of any EOIs.
All notices in regards to this EOI will be forwarded to the address provided by
submitters in their EOI.
Proposals should be completed using the Expression of Interest Form that is
attached to this document.
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2.5 Background information
Documents relevant to this EOI can be accessed through the Ministry of Health’s
website: http://www.moh.govt.nz/primaryhealthcare
Funding and Contracting arrangements
Funding to support the business development pathway will be negotiated as part of
the business case development stage.
There are three funding sources that may be merged as part of contracting for
service provision:
(i) More flexible use of existing funding streams in primary health care including
core capitation and its premiums where appropriate (eg Very Low Cost Access,
Care Plus, Services to Improve Access, Health Promotion, Get Checked –
Diabetes, PHO Management Fees).
(ii) Capital investment is expected to come from the private or NGO sector;
however there may be a few instances where publicly funded capital (e.g.
through agreement with DHBs) can be made available.
(iii) Where appropriate, further funding devolved from DHBs and/or other parts of
Vote:Health.
You may wish to indicate how you could use your existing revenue streams more
flexibly to support the delivery of services under this model.
Any major funding risks that could jeopardise the viability of a business case for this
development should be identified.
The process of agreeing final funding and contracting arrangements may involve
examining all the available revenue in a locality, whether it is from primary or
secondary care, and giving providers more autonomy to determine the best way to
fund enhanced models of care for a community.
Multi-year agreements are likely and will be considered as part of the contracting
terms and conditions in order to provide sufficient certainty of revenue to underpin
investment by providers in new facilities and business transformation processes.
2.6 General enquiries
General enquiries about this EOI must be made to the Ministry’s Better, Sooner,
More Convenient email address: BSMC@moh.govt.nz
Responses will be published on GETS and will be available to others who have been
provided with this EOI.
The Ministry is not obliged to address any enquiries received within seven (7)
calendar days prior to the Closing Date specified in clause 2.4.
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Proposers must not:
• Contact any person at the Ministry regarding this EOI except through the
BSMC@moh.govt.nz email address;
• Approach or directly or indirectly lobby, attempt to influence or provide any
form of incentive to, any representative of the Ministry concerning any aspect
of this proposal process. Any proposer who either directly or indirectly
makes any such approach may be disqualified;
• Make any public statement in relation to this EOI, the EOI process, your
proposal or participation in the EOI process, without the Ministry’s prior
written consent.
2.7 Confidentiality
If your proposal contains information that you consider should be held confidential
you are advised to clearly identify such information and indicate the reason(s) why
you consider the information should be held confidential.
Please note that information held by the Ministry is subject to request(s) under the
Official Information Act 1982. The Ministry also has other obligations in relation to
information, such as reporting to Parliament and a duty to consult other interested
parties at any time during the process.
The Ministry may also release summary information about the successful
proposer(s).
2.8 Ownership of proposal documents
All proposal documents will become the property of the Ministry on lodgement.
Ownership of the intellectual property rights in a proposal does not pass to the
Ministry with the lodgement of the proposal. However in submitting a proposal, the
proposer grants the Ministry a licence to retain, use, disclose and copy the
information contained in any proposal document for the purposes of:
• Evaluating or clarifying the proposal;
• Evaluating any subsequent proposal;
• Negotiating any resultant contract;
• Managing a contract with the successful proposer (if any);
• Responding to any challenge to the EOI process, audit and complying with
governmental and parliamentary reporting requirements or request for
information; and
• Any other purpose related to the EOI process or above purposes.
2.9 Disclaimer
There is no intention that the EOI process creates legal relations between the
Ministry and those submitting an EOI. This EOI may result in negotiations with a view
to entering a contract for services, but of itself is not an offer that proposers accept
by submitting proposals. Instead, this EOI is to be based on common law relating to
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proposals, being that the EOI is an invitation to treat and each proposal is an offer
upon which the Ministry may negotiate with a view to acceptance once a written
contract is executed. Accordingly, proposers should take note that in relation to
proposals submitted, negotiations entered into before execution of a written contract
are negotiations only, and are not binding until the execution of a written contract. In
this context, your attention is drawn to the proposal selection process in Section 4
below.
The Ministry is not liable (whether in contract, tort or otherwise) for any liability, loss
(including a direct, indirect or consequential loss), cost or expense arising from your
proposal or from the preparation or lodgement of your proposal.
Proposers and their officers, employees, agents and advisers must not engage in
any collusion, anti-competitive conduct or any similar conduct with any other
proposer or person in relation to the preparation or lodgement of their proposals.
This EOI, and any contract(s) that may be established as the result of this EOI, is
governed by New Zealand law.
o Proposals shall remain valid for a period of 180 days from the Closing Date.
o
By responding to this EOI, you accept the terms and conditions of this EOI
and the EOI process.
3. Content of your Expression of Interest
Please include the following information in your EOI:
3.1 Title of the EOI
3.2 Organisation details
• Full legal name of your organisation.
• Postal and service addresses of your organisation.
• Name of your contact person and their contact details.
• The size of the organisation (eg. staff, location(s), turnover).
• Management structure and key managers by name, title and role.
3.3 Your Proposal
Your proposal should demonstrate your ability to implement large scale and
transformational improvement to a significant majority of your practices/providers
within the next three years.
This should include a focus on early implementation of Integrated Family Health
Centres, demonstrating a different patient experience for all enrolees within three
years.
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You must also demonstrate that you can provide the services needed to serve your
population in a cost effective manner, including consideration of the potential impact
on your local or regional health sector.
It is expected that you will need to progressively implement your proposed service
improvements. Your proposal should outline how you envisage developing and
implementing IFHCs and new service models over time. This will include signal key
milestones and indicative dates for implementation where appropriate.
We require your proposal to:
(i) Show how initiatives that you will implement, will help:
• deliver the Government’s Health Targets (e.g. shorter stays in Emergency
Departments, better diabetes and cardiovascular services, increased
immunisation, improved access to elective surgery)
• contribute to health sector productivity (e.g. better acute demand
management) and:
• deliver quality improvements (e.g. through better chronic care management)
and services that are more consistent with national guidelines, including
approaches to prioritisation;
(ii) Describe the package of services and associated business model you propose,
which should include most of (but not be limited to):
• The range of services to be provided in primary care to enable access to a
wider range of services closer to home. You should describe the:
o Revised clinical pathways across primary and secondary care that will
lead to reduced hospital admissions and care being provided closer to
home;
o Devolved secondary services (e.g. diagnostics, first specialist
assessments)
• Additional health services that would be provided to provide flexibility and
meet the needs of communities more effectively. This may include;
o Extended opening hours, telephone and email consultations, walk-in
access and nursing clinics;
o The provision of day-stay surgical procedures and observation beds;
o Coordinated models of care, including increased support for chronic
care management and the care of frail elderly;
o Potential integration of social care according to the priorities of local
communities;
o Individuals taking greater responsibility for managing their own health;
• The role of multidisciplinary teams and increased collaboration with nursing,
allied health professionals, and secondary care specialists so that patients
are provided with faster more effective services.
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(iii) Show that you have the organisational infrastructure and capability to implement
large scale and transformational improvement, including all of the following:
• Transparent ownership and governance arrangements;
• Clinical governance and leadership that has direct input into decision making
and implementation of improvements;
• Engagement with secondary care providers including hospital specialist
clinicians;
• Information management development that can enable new models of care,
improve quality and efficiently deliver services;
• Where appropriate, capability to deliver services that are consistent with
Whānau Ora approaches;
• Capacity to provide improved workforce development opportunities, such as
training facilities to support primary health care placements for a variety of
disciplines (e.g. general practice, nursing, allied health);
• Processes to meaningfully engage consumers and the community.
• The level of any DHB involvement and/or support for your proposal.
(iv) Implementation of IFHCs
• This proposal will include a description of the Integrated Family Health
Centres (including likely sites) you are aiming to establish within 12 months,
two and three years, and whether these are in new, existing and/or DHBowned
facilities.
4. EOI Assessment Process
4.1 Assessment Panel
An assessment panel, whose members will be drawn from the sector and Ministry,
will be established to consider and assess the EOIs against this EOI document and
the assessment criteria below. The Ministry will be the final arbiter.
4.2 Assessment criteria
In addition to the requirements outlined in this EOI document, proposals will be
evaluated along three major dimensions:
(i) The nature and expected magnitude of benefits that will flow from the
proposed service improvement initiatives, including how the proposal expects
to:
• Support the delivery of the Government’s key health targets;
• Contribute to health sector productivity and quality improvement;
• Lead to the rapid establishment of Integrated Family Health Centres in
appropriate locations;
• Support the shift of services from secondary care to primary care;
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• Reduce acute demand on publicly funded hospital services;
• Ensure a wider range of health services are delivered including but not
limited to extended hours, walk-in access, telephone and email
consultations, laboratory specimen collection and some on-site processing,
day-stay surgical procedures and observation beds;
• Support better management of patients with chronic conditions to slow
disease progression;
• Increase the use of the wider primary health care workforce and support
multidisciplinary teams;
• Provide for workforce development, training and innovation in the primary
care setting;
• Achieve the above objectives in a way that is cost effective and assures
quality and safety for users of services.
(ii) The capability and capacity of the respondent to deliver major service
improvement initiatives in support of these benefits, including:
• Ownership and governance arrangements;
• Strength and experience of the clinical leadership;
• Financial strength and viability;
• Change management ability and experience in the health sector across the
primary and secondary sector;
• Information management experienced that enables new models of care, and
improves quality and efficiently deliver services.
(iii) The strength of relationships between the various parties, and partnership
arrangements with key stakeholders, including;
• the degree of engagement and/or support from DHBs, specialist clinicians,
practitioners from a range of disciplines;
• Experience in meaningful engagement with consumers and the community.
4.3 Disclaimer
The Ministry’s preference is to select proposals on the basis of this EOI. However,
the Ministry may (at its option) consider non-conforming EOIs. Any non-conforming
EOIs should clearly identify the aspects of your EOI that do not conform to the EOI
requirements.
In considering your EOI, the Ministry may ask you for further information, or to verify
information, in relation to any aspects of your EOI.
If the Ministry's discussions with submitters or other circumstances make it
necessary to extend the indicative date by which the Ministry wishes to select
submitter(s) in clause 2.3, the Ministry may notify parties who have submitted an EOI
of the necessary extension of time.
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The Ministry reserves the right at any time to:
• Accept or reject all or any EOI;
• Consider, accept, or reject any non-conforming EOI, at the Ministry’s sole
discretion;
• Suspend or cancel (in whole or in part) this EOI and the EOI process at any
time;
• Re-invite EOIs;
• Seek additional EOIs;
• Waive any irregularities or informalities in the EOI process;
• Amend any timetable in this EOI;
• Amend this EOI, or any associated documents, by the issue of a written
amendment notice;
• Consult with the public and/or any other party interested in the delivery of the
required services;
• Notify all other submitters and offer any of the other submitters the
opportunity to amend their EOIs where, as a result of one or more EOIs
received or for any other reason, the Ministry decides to change the services
that the Ministry intends to purchase;
• Select any party for the subsequent request for proposal process, whether or
not that party has submitted a EOI;
• Not enter into any contract in relation to the matters described in this EOI.
5. Other Information
5.1 Expectation for participants to share experience and
information
Other primary health care organisations will be able to learn from the experience of
the early adopters identified through this EOI process. It is therefore expected that
successful applicants will:
• Participate in initiatives by the Ministry or DHBs to learn from their
experience to inform ongoing policy development and understanding of cost
impacts;
• Provide easily accessable information to the public about the primary health
services being delivered, particularly in relation to health targets and PHO
performance indicators;
• Where appropriate, participate in initiatives for training health professionals
(undergraduate and postgraduate);
• Seek consumer feedback and community input into the development of
services and their ongoing performance.
To the extent possible, the Ministry will seek to streamline information reporting
requirements by aligning them with its contract monitoring process.
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